Hospitalized inpatients often experience sleep deprivation due to environmental noise and interruptions from staff. A new study in the June 2021 issue of The Joint Commission Journal on Quality and Patient Safety implemented a nonpharmacologic sleep hygiene bundle intervention to improve patients’ sleep.

The study, “A Sleep Hygiene Intervention to Improve Sleep Quality for Hospitalized Patients,” used the Richards-Campbell Sleep Questionnaire (RCSQ) and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night to measure self-reported sleep for patients on a general medicine unit. (The study did not seek to decrease the frequency of medical interventions overnight, focusing only on sleep hygiene.)

The sleep hygiene bundle is composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, ear plugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime, and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with the implementation.

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A total of 931 patients received the sleep intervention. In a sample of surveyed patients, the RCSQ global score increased from 6.0 to 6.2 from the pre- to post-intervention periods, as well as in three of the five individual survey components. Additionally, the HCAHPS “quietness at night” score increased from 34.1% to 42.5% from the pre- to post-intervention periods.

The researchers conclude that a nonpharmacologic sleep hygiene protocol, paired with provider education and use of champions, were associated with modest improvements in patients’ perceived sleep.

“As we consider this study, it is worth noting that hospital sleep is not just a patient experience issue; it also can exacerbate chronic health issues for many adult patients. Even short-term disruptions in sleep lead to deleterious effects on metabolic regulation, immune function, wound healing, mental health and development of delirium,” notes an accompanying editorial by Nancy H. Stewart, DO, MS, and Vineet M. Arora, MD, MAPP.

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